090100_Inspection_20200211

woman of Water ResourcesWM
m
Type of Visit: Oebm iance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 5 Departure Time: County:�Region:
ckk & I —
Phone:
Owner Email:
Farm Name
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ffelnti_A Title:
Onsite Representative:
Certified Operator: .S (fit
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: L
Certification Number:
Longitude:
.°
[Besagn Current
Design Current ;`
-
Resign Curr n
me,CapacityJE'op.�VetPonitry
Capacity Poi
CattleCapac�ty
.Pop
d am
Wean to Finish
Layer'_
Dairy Cow
Wean to Feeder
Non-La er I
Dairy Calf -_
Feeder to Finish�
Dairy Heifer
Farrow to Wean
�( (r
Desigm Ca�rrent
Dry Cow
Farrow to Feeder
.Drr >PQuliry .'°Ca
ggg-
sac „Pop
Non -Dairy _
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
�
-� �r
Other
urkey Poults
s
Other
Other
22
- _
- -
Discharees and Stream InMacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ER'Ko-
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
�A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
ErNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E� No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
En�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - JbQ jDate of Inspection: Z0-ZZ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
"I Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NAB❑ NE
❑ No QTIA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes rNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
• No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0_90_ ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
= No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E N ❑ NA ❑ NE
❑ Excessive Ponding " ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): S6 0
13. Soil Type(s):
vpl 14
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
EKo
❑ NA
❑ NE"
❑ Yes
D o
❑ NA
❑ NE
❑ Yes
D-No
❑ NA
❑ NE
❑Yes D11 o ❑NA ❑NE
❑ Yes �o ❑ NA ❑ NE
Did the facility fail to have the Certificate of Coverage & Permit readily available? Elle's ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FI--lqo
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
El Yes
0 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F(No
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - 0 C> jDate of Inspection: l j F�lr `Lc7
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
2<0
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
D-No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the f.\ ity? If yes, check the appropriate box below.
❑ Application Field ❑Lag Ibrage Pond ❑ Other:
32. Were any additional problems noted whidi cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss view/inspection with an on -site representative?
34. Does the facility require a follow'visit by the same agency?
4F-11 9-e-e-P a4-,r4 C b C
C4- gIUA 3oE,-�95I
Reviewer/Inspector Name: D
Reviewer/Inspector Signature:
❑ Yes
D40
❑ NA
❑ NE
❑ Yes
❑--TVo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
El 1Vo
❑ NA
❑ NE
❑ Yes
u wu
❑ NA
❑ NE
❑ Yes
E- , o
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
Date:"�l7 �' v
2141201 S
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